Wristband Standardization Project Joint Project Sponsors: Colorado Hospital Association (CHA) Colorado Foundation for Medical Care (CFMC)

Background Wristbands meant to designate a certain medical condition should be consistent throughout healthcare facilities. Certain colors become associated with certain medical conditions. Multiple wristband colors in use for the same medical condition is a patient safety concern.

Background Results from a survey of 57 Colorado hospitals showed: 5 different wristband colors in use for both DNR and Allergy designation. 6 different wristband colors in use for both Latex Allergy and Fall Risk designation

National Work on Wristband Standardization Pennsylvania and Arizona were first states to implement wristband standardization. Many other states, especially in southwest region, are currently working on similar projects.

Arizona and Pennsylvania Recommendations ArizonaPennsylvania DNR PurpleBlue Allergies Red Fall Risk Yellow Latex Green*Green Restricted Extremity Pink*Pink *Arizona is not currently recommending that all hospitals use Latex or Restricted Extremity bands, however they recommend the suggested colors if state hospitals prefer to use a separate band for these medical conditions.

Arizona and Pennsylvania Facts ArizonaPennsylvania Number of hospitals in the state adopting the standardization model 100% hospital commitment from CEOs 11 hospitals Mandated through state legislature No Other states moving forward with same color adoption 1.New Mexico 2.Utah 3.Nevada 4.California 5.Wyoming 6.Oregon 7.Washington 8.Montana 9.Oklahoma 10.West Virginia None at this time

Recommendations for Wristband Standardization in Colorado Follow Arizona model 10 other states, mostly in southwestern region, are also considering the Arizona model AllergyRED DNRPURPLE Fall RiskYELLOW Latex Allergy GREEN Restricted Extremity PINK

Why Consider Regional Adoption? Colorado receives nurses most often from New Mexico and Oklahoma. Colorado nurses are most likely to travel to Arizona and California. We share borders and patients with states that are currently considering the recommended model.

ANSWERS TO FREQUENTLY ASKED QUESTIONS

DNR - Why not use blue? Patient safety is about eliminating any potential for confusion Code Blue = Resuscitate Patient Blue Wristband = DO NOT Resuscitate 73% of Colorado hospitals currently use Code Blue to alert medical staff of a COR

ANSWERS TO FREQUENTLY ASKED QUESTIONS

DNR - Why use Purple? Purple is the most distinctive color option available Orange too close in the color spectrum to red and yellow, which are currently being used to designate allergies and fall risk, respectively Green currently being used to designate a latex allergy

DNR - If using the purple band, do we still need to look in the chart? Yes. A chart should always be reviewed even if alert wristbands are used. It is important to know the current status of an advanced directive so that a patient’s and/or family’s wish can be honored.

Allergies - Why use red? Results of the hospitals surveyed showed that the majority of Colorado hospitals already use the color red.

Allergies - Do we write the allergies on the wristband too? It is recommended that allergies be written in the medical record according to your hospital’s policy and procedure. It is suggested that allergies not be written on the wristband for a couple of reasons including: Legibility Assumption that list is comprehensive and up- to-date

Fall Risk - Why did you select yellow? Yellow has an association that implies “caution” Caregivers would want to have knowledge to use caution with a patient who has a history of previous falls, dizziness, balance problems, weakness or confusion about their current surroundings.

Any barriers to implementation? Both Arizona and Pennsylvania have noted little staff resistance. Cost was not noted as a major barrier in either state Education was not noted as a barrier Both states provided hospitals with toolkits that contained educational materials

Additional Questions Donna Kusuda Chair of Quality Professionals’ Group (CHA) HCA/HealthONE Crystal Berumen Colorado Hospital Association (CHA) Cari Fouts Colorado Foundation for Medical Care (CFMC)